Liposomal amphotericin B (AmBisome) compared with amphotericin B both followed by oral fluconazole in the treatment of Aids-associated cryptococcal meningitis
| Autor: | Jan C. C. Borleffs, S. de Marie, Philip Jones, Jennifer F Hoy, R.H. Kauffmann, T. Allworth, Frank P. Kroon, A. C. A. P. Leenders, P. Portegies, Peter Reiss, Clezy K, Henri A. Verbrugh, W. C. J. Hop |
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| Přispěvatelé: | Medical Microbiology & Infectious Diseases, Epidemiology, Faculteit der Geneeskunde, Other departments |
| Rok vydání: | 1997 |
| Předmět: |
Adult
medicine.medical_specialty Antifungal Agents Adolescent Immunology Administration Oral Meningitis Cryptococcal Gastroenterology Drug Delivery Systems Therapeutic index SDG 3 - Good Health and Well-being Amphotericin B Amphotericin B deoxycholate Internal medicine Outcome Assessment Health Care medicine Humans Immunology and Allergy Fluconazole Mycosis Cryptococcus neoformans AIDS-Related Opportunistic Infections biology business.industry medicine.disease biology.organism_classification Surgery Infectious Diseases Liposomes Cryptococcosis Drug Therapy Combination business Meningitis medicine.drug |
| Zdroj: | AIDS, 1463-1471. Lippincott Williams & Wilkins (Wolters Kluwer) ISSUE=11;STARTPAGE=1463;ENDPAGE=1471;ISSN=0269-9370;TITLE=AIDS AIDS, 11, 1463-1471. Lippincott Williams & Wilkins AIDS (London, England), 11(12), 1463-1471. Lippincott Williams and Wilkins |
| ISSN: | 1473-5571 0269-9370 |
| Popis: | OBJECTIVE: Amphotericin B deoxycholate initial therapy and fluconazole maintenance therapy is the treatment of choice for AIDS-associated cryptococcal meningitis. However, the administration of amphotericin B is associated with considerable toxicity. A potential strategy for reducing the toxicity and increasing the therapeutic index of amphotericin B is the use of lipid formulations of this drug. DESIGN AND METHODS: HIV-infected patients with cryptococcal meningitis were randomized to treatment with either liposomal amphotericin B (AmBisome) 4 mg/kg daily or standard amphotericin B 0.7 mg/kg daily for 3 weeks, each followed by fluconazole 400 mg daily for 7 weeks. During the first 3 weeks, clinical efficacy was assessed daily. Mycological response was primarily evaluated by cerebrospinal fluid (CSF) cultures at days 7, 14, 21 and 70. RESULTS: Of the 28 evaluable patients, 15 were assigned to receive AmBisome and 13 to receive amphotericin B. Baseline characteristics were comparable. The time to and the rate of clinical response were the same in both arms. AmBisome therapy resulted in a CSF culture conversion within 7 days in six out of 15 patients versus one out of 12 amphotericin B-treated patients (P = 0.09), within 14 days in 10 out of 15 AmBisome patients versus one out of nine amphotericin B patients (P = 0.01), and within 21 days in 11 out of 15 AmBisome patients versus three out of eight amphotericin B patients (P = 0.19). When Kaplan-Meier estimates were used to compare time to CSF culture conversion, AmBisome was more effective (P 21 days for amphotericin B). AmBisome was significantly less nephrotoxic. CONCLUSIONS: A 3-week course of 4 mg/kg AmBisome resulted in a significantly earlier CSF culture conversion than 0.7 mg/kg amphotericin B, had equal clinical efficacy and was significantly less nephrotoxic when used for the treatment of primary episodes of AIDS-associated cryptococcal meningitis |
| Databáze: | OpenAIRE |
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